The generally increasing costs of medical care and hospitalization in state run or trust run hospitals is a matter of great concern. Providing quality medical care at an affordable rate, without in any way compromising end results is the buzzword of institutional practice. FNAC is a diagnostic modality, which helps lower the costs of pre-operative work-up and hospitalization, and at the same time provides results with high specificity and sensitivity. The raging popularity of FNAC in general however did not affect or significantly alter the preoperative work-up of skeletal lesions. The reasons for this are two-fold: (i) bone tumours are uncommon, (ii) and more importantly, the stakes involved while dealing with bone tumours are high. Hence, although FNAC of bone was first attempted in the 1930's by Martin & Ellis ¹ and later by Stromby and Ackerman (1973)², neither orthopaedicians nor pathologists were much enthused by skeletal FNAC The ease, simplicity, speed and cost³ of FNAC coupled with the popularity of neoadjuvant chemotherapy and limb sparing procedures for malignant bone tumours, has revived interest in bone FNAC as highlighted by the numerous recent publications on this subject comprising sizeable number of cases^4-17. The ensuing comments are based on experience of the past 13 years (since 1987) at a major cancer hospital, which accessions on an average 110 – 180 bone FNAC's per year. The data used in this article is based on an analysis of 518 cases of skeletal FNAC accrued during the period - 1987 to 1990. An element of institutional as well as personal bias is hence, inevitable in this review. The practice of FNAC of bone published from various Indian centers, comprising both series ^18-25 as well as case reports ^26-38, as well as publications from international centers, has been collated to evaluate the scope and limitations of this procedure. The first part of this article will deal with the technique of bone FNAC, optimization of aspirated material, factors which decide yield and adequacy, evaluation and classification of the smears and a comparison of both Indian and world data on skeletal FNAC. The second part will deal with cytomorphological observations on individual histologic entities together with the expectations and the scope and limitations.

Fifty infertile males between the age of 21-45 years were studied to evaluate the diagnostic role of FN A testis in infertile men. Semen analysis, and FNA on one testis was done in all the cases. In 30/50 cases a biopsy was also taken for histopathological examination. On semenogram 32 (64%) had azoospermia while 18 (36%) had oligospermia. Cytomorphology of FNA smears revealed normal spermatogenesis in 20 (40%), hypospermatogenesis 4 (8%) and maturation arrest 11 (22%), Sertoli cell only testis 4 (8%) and granulomatous orchitis 3 (6%). In 8 (16%) cases where scant smears were obtained on FNA, diagnosis could not be made, thus making the diagnostic accuracy of FNA as 84%. In all the 30 cases subjected to biopsy, adequate material was obtained and a correct diagnosis could be reached at. Findings of cytological examination and histopathological examination were correlated and a concordance of 86.3% was found in this study. FNA of testis was found to be highly accurate, reproducible and minimally invasive procedure for diagnosis of infertile males.

A comparative study was undertaken to evaluate efficacy of sterilised swab sticks with commercially available ‘Detecta’ kits for collection of adequate cervical smears for early detection of cervical cancer. The study was carried out in 350 women each, in whom swab stick and “Detecta” was employed for getting ecto and endocervical smears. “Detecta” was found to be very effective in obtaining adequate samples from both the sites. The false negative cytology for carcinoma cervix was found to be only 7.2% in our series of cytological screening in 22,157 women in whom swab stick was used for taking ectocervical smears. Hence it is felt that swab stick can be continued to be used for routine screening considering its negligible cost and easy accessibility. However, If the patient can afford to purchase or in specific cases such as endocervicitis, ‘Detecta’should be used.

This study was conducted to study the cytomorphological features of thyrogiossai cysts on fine needle aspirates. 84 cases were studied over a period of eleven years from 1982-1992. The histopathological slides were available in 14 cases only and the morphological features were evaluated in these cases. Squamous cells were seen in 71 cases (87.65%) whereas mucus secreting columnar cells and ciliated columnar cells were seen in 23.4% and 12.3% cases respectively. Follicular cells and colloid were seen infrequently in 8.6% and 9.8% cases respectively. Cholesterol crystals were observed in 7.4% cases only. Thus, the cytological diagnosis of thyrogiossai cysts can be difficult when thyroid follicles and colloid are not seen. However, in the proper clinical setting a cytologic diagnosis of thyrogiossai cyst should be considered when ciliated/mucus secreting columnar cells are seen along with squamous cells.

A comparative study of the non-aspiration technique (FNC) with the conventional FNAC is reported in one hundred lesions at different sites. The former technique is based on the principle of capillary action. The sampling was assessed using 3 parameters.

1. Cellular yield
2. Cell architecture preservation
3. Blood & clots in the background.

In contrast to FNA sampling, FNC is simple, less traumatic with minimal blood in the background yielding superior quality material in 68% cases at a statistically significant rate. (p<0.01)

With the increasing use of fine needle aspiration cytology (FNAC) as a diagnostic procedure, cytologic diagnosis is being used to determine treatment protocols without recourse to surgical biopsy and histologic confirmation. FNAC is a powerful tool in the diagnosis and management of bone tumors in cancer practice. Here we report one such case of a 11-year old Sikh boy who presented with shoulder mass, in whom the diagnosis of Ewing's Sarcoma was made by FN aspirate material which showed presence of small round cells with monomorphic nuclei and PAS positivity in the cytoplasm, thus highlighting the utility of FNAC in giving a rapid and reliable preoperative diagnosis.

Oncocytic carcinoid is a morphologic variant of carcinoid tumors of the lung. These are extremely rare tumors. We report the fine needle aspiration cytology (FNAC) findings in a primary oncocytic carcinoid of the lung.

Tubular carcinoma (TC) and tubulolobular carcinoma (TLC) are uncommon types of breast carcinoma that behave less aggressively than invasive ductal and lobularcarcinoma. Theiroften bland cytological features sometimes make it difficult to recognize these lesions as malignant on fine needle aspiration (FNA) smears. FNA smears from two cases of TC and one case of TLC were reviewed. Cellularity varied from mild to high and a mixed tubular-acinar and dissociated pattern of cells was seen. Small clusters of cells with occasional clusters showing angulated ends were seen in all three cases. Tumor cells were small or intermediate-sized with high nuclear:cytoplasmic ratios. Nuclei were round or oval and vesicular with occasional micronucleoli. Mitotic activity was low. A cytologic diagnosis of “consistent with invasive breast carcinoma” was made in all three cases. TCs and TLCs manifest a tubular-acinarpattern of small or intermediate-sized cells on cytological smears. A characteristic feature is the presence of glands with pointed (arrowhead) pattern. Dissociated cells may be present in fair numbers, especially in TLC. Features such as cell dissociation, high nuclear:cytoplasmic ratio and mild pleomorphism are helpful in recognizing these lesions as malignant.

A 56 years old lady presented with pain and distension in the lower abdomen. Ultrasound showed a huge left ovarian cyst, which was surgically excised. Histopathology confirmed it to be - mucinuous cystadenocarcinoma ovary. A month later, she complained of continuing weight loss and pain in the right hypochondrium. Ultrasound abdomen revealed a solitary mass in the liver and growths in the gall bladder, common bile duct and lymph nodes. Guided FNAC showed evidence of metastatic deposits of mucinous cystadenocarcinoma ovary in these sites. The case is being presented due to its rarity.